02/07/2018 01:30 PM House FINANCE

HOUSE BILL NO. 215                                                                                                            
                                                                                                                                
     "An Act relating to program receipts; and relating to                                                                      
     fees for services provided by the Department of Health                                                                     
     and Social Services."                                                                                                      
                                                                                                                                
2:07:02 PM                                                                                                                    
                                                                                                                                
Co-Chair Foster noted  that the bill had last  been heard on                                                                    
February 2, 2018.                                                                                                               
                                                                                                                                
ELIZABETH  DIAMENT, STAFF,  REPRESENTATIVE PAUL  SEATON, had                                                                    
no additional information to share with the committee.                                                                          
                                                                                                                                
Vice-Chair  Gara asked  why $600,000  in additional  revenue                                                                    
from the  fees only resulted  in a reduction of  $200,000 in                                                                    
undesignated general funds (UGF).                                                                                               
                                                                                                                                
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
DEPARTMENT OF HEALTH AND SOCIAL  SERVICES, answered that the                                                                    
$200,000 reductions  to the general  fund (GF) was  based on                                                                    
the only  applicable program that  had existing  funding and                                                                    
was  used  to  craft  the   fiscal  note.  The  fiscal  note                                                                    
reflected that GF expenditures would be replaced by fees.                                                                       
                                                                                                                                
2:09:22 PM                                                                                                                    
                                                                                                                                
Representative   Kawasaki   noted  that   implementing   fee                                                                    
collection  was a  long  process. He  was  aware of  program                                                                    
receipt authority  placed in  the budget  and the  fees were                                                                    
never collected. He  asked for comments from  Ms. Lewis. Ms.                                                                    
Lewis  answered that  the issue  had been  addressed in  the                                                                    
fiscal note  by not  showing any  receipts collected  in the                                                                    
first year,  FY 2019. She  explained that in the  first year                                                                    
she expected  the division to  develop regulations  and hold                                                                    
meetings with  stakeholders. The  division hoped  to collect                                                                    
fees the following year. Representative  Kawasaki spoke to a                                                                    
provision related to waiving fees  in Section 2 of the bill.                                                                    
He  recounted  that  the  commissioner  can  waive  fees  if                                                                    
collection  was  deemed  not   feasible  or  in  the  public                                                                    
interest or if they  undermined the division's public health                                                                    
mission. He asked for more  detail about when in the process                                                                    
it was  determined a fee  undermined the mission.  Ms. Lewis                                                                    
replied that it  was a subjective analysis;  there were many                                                                    
things to weigh  in order to judge whether  something was in                                                                    
the  public's interest  or  would  undermine the  division's                                                                    
mission to  protect or promote  the health of  Alaskans. She                                                                    
explained that the  division would not pursue a  fee that it                                                                    
or stakeholders determined would  not achieve the division's                                                                    
goals. At some point a fee  could become a barrier to taking                                                                    
advantage  of services,  which would  negatively impact  the                                                                    
public's health.                                                                                                                
                                                                                                                                
2:12:00 PM                                                                                                                    
                                                                                                                                
Representative Guttenberg stated that  in a separate bill he                                                                    
was  working  on,  the administration  was  concerned  about                                                                    
raising fees  that would impact  state employees.  The state                                                                    
was anticipating  rising healthcare  costs. He asked  if the                                                                    
Department of  Administration (DOA) weighed in  on the issue                                                                    
regarding how the bill would  affect the cost of healthcare.                                                                    
Ms. Lewis  asked for clarification.  She wondered if  he was                                                                    
asking  that  by  filling  the   positions  there  would  be                                                                    
additional   healthcare  costs.   Representative  Guttenberg                                                                    
explained by  filling the position  and instituting  fees by                                                                    
the  department.  He asked  if  the  bill affected  employee                                                                    
healthcare  costs  in  anyway.  He  asked  whether  DOA  had                                                                    
expressed concerns.  Ms. Lewis replied in  the negative. She                                                                    
explained  that   the  positions  would  not   impact  state                                                                    
healthcare costs.                                                                                                               
                                                                                                                                
Representative Wilson asked for  verification the bill would                                                                    
charge patients. She asked whether  the charge was a sliding                                                                    
fee. Ms.  Lewis answered  that the department  currently had                                                                    
the  authority to  collect fees  for clinical  services like                                                                    
lab  fees, specialty  clinics, and  public  nurse fees.  She                                                                    
listed services  the department could  not charge  fees for;                                                                    
professional services,  consultations, technical assistance,                                                                    
specialized  data   analysis,  and   certain  administrative                                                                    
services.  The  costs  would generally  be  charged  to  the                                                                    
entity  that utilized  the services  but  not to  individual                                                                    
members of the public.                                                                                                          
                                                                                                                                
2:14:57 PM                                                                                                                    
                                                                                                                                
Vice-Chair Gara  thanked Ms. Lewis,  Ms. Diament  and others                                                                    
for their  work. He shared  that the previous year  the DHSS                                                                    
finance subcommittee recommended  the department charge fees                                                                    
for  certain  services  that were  not  thoroughly  "fleshed                                                                    
out." He appreciated the  department's and Co-Chair Seaton's                                                                    
follow up.                                                                                                                      
                                                                                                                                
Vice-Chair  Gara reviewed  the new  fiscal impact  note from                                                                    
the Department  of Health and  Social Services  allocated to                                                                    
Public  Health  Administrative  Services.  The  fiscal  note                                                                    
reflected a  $200,000 expected reduction  in UGF in  FY 2020                                                                    
and  anticipated  raising  $600,000  in revenue  for  a  net                                                                    
positive of $400,000.                                                                                                           
                                                                                                                                
Representative Wilson asked what  data was used to determine                                                                    
the  numbers. Ms.  Lewis admitted  that a  certain level  of                                                                    
uncertainty existed  because the  proposed type of  fees had                                                                    
never  been   collected  before.   She  analyzed   each  fee                                                                    
individually  to  determine the  volume  and  guessed at  an                                                                    
amount for a  reasonable fee. The fee could be  no more than                                                                    
cost. The division had made  the best attempt at identifying                                                                    
what was necessary to support  the program and an amount for                                                                    
a fee that was possible to collect.                                                                                             
                                                                                                                                
2:17:34 PM                                                                                                                    
                                                                                                                                
Co-Chair  Seaton  MOVED  to  REPORT  CSHB  215(FIN)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal  note. There being NO  OBJECTION, it was                                                                    
so ordered.                                                                                                                     
                                                                                                                                
CSHB  215(FIN) was  REPORTED  out of  committee  with a  "do                                                                    
pass"  recommendation and  with one  new fiscal  impact note                                                                    
from the Department of Health and Social Services.                                                                              
                                                                                                                                
2:18:14 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
2:22:39 PM                                                                                                                    
RECONVENED